一个随机的,双盲的,分级的剂量反应研究,用于预防在选择性剖腹产期间的脊柱后低血压,对诺亚上腺素的管理
Volkan Baytaş1, Süheyla Karadağ Erkoç1, Menekşe Özçelik1
1Department of Anaesthesiology and ICM, School of Medicine, Ankara University, 06230 Ankara, Türkiye.
Journal of clinical medicine
|October 28, 2023
概括
上腺素有效地预防剖腹产后脊柱性低血压. 中等剂量-玻尿酸,中等剂量-输液组合显示最低的低血压发病率和改善新生儿Apgar分数.
科学领域:
- 麻醉学 麻醉学
- 产科 产科 产科 产科 产科
- 药理学 药理学是指药理学的学科.
背景情况:
- 上腺素是预防剖腹产期间脊柱后低血压的新选择.
- 在这种情况下,还没有确定诺阿基因的最佳剂量策略.
研究的目的:
- 为了比较三种不同的诺亚上腺素剂量方案 (玻尿酸和输液组合),用于剖腹产期间预防脊柱后低血压.
- 评估这些疗法对低血压,高血压,心和新生儿结局的影响.
主要方法:
- 一项随机的双盲研究,涉及192名分娩妇女,她们在脊髓麻醉下进行剖腹产.
- 患者被分配到三个组:零-博洛斯高输注 (ZBHI),中等-博洛斯中等输注 (MBMI) 和高-博洛斯低输注 (HBLI) 的诺亚上腺素.
- 脊髓麻醉涉及布皮瓦卡因和芬太尼; 在收集脑脊液后立即启动诺亚上腺素协议.
主要成果:
- 脊柱后低血压的发生率在MBMI组 (1.7%) 最低,其次是ZBHI (6.7%) 和HBLI (11.7%).
- 在HBLI组表现出后脊柱性心 (8.3%) 和高血压 (11.7%) 的最低频率.
- 新生儿1分钟的Apgar分数在MBMI组明显高于ZBHI组 (8.58比8.23).
结论:
- 所有测试的诺亚上腺素疗法都有效地减少了剖腹产期间的脊柱后低血压.
- 推使用高玻尿酸剂 (10微克) 接下来是低输液 (0.05微克公斤-1 min-1) 的上腺素治疗方案,因为心脏和高血压的发病率较低.
- 中度玻尿酸,中度输液策略也表现出有希望的结果,低血压发生率最低,新生儿结果有所改善.
相关概念视频
Local Anesthetics: Clinical Application as Epidural Anesthesia
439
Epidural anesthetics are administered in the fat-filled epidural space, the outermost part of the spinal canal. This technique is commonly employed for pain management and anesthesia during lower abdomen and pelvis surgeries or labor and delivery.
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
439
Cardiopulmonary Resuscitation IV: Pharmacological Management
12
Pharmacologic intervention is crucial in treating cardiac arrest patients during ACLS or Advanced Cardiovascular Life Support. The ACLS algorithms guide the administration of specific drugs based on the patient's cardiac arrest rhythm, which includes pulseless ventricular tachycardia (VT), ventricular fibrillation (VF), asystole, and pulseless electrical activity (PEA).EpinephrineIndication: Epinephrine is the first-line drug for all cardiac arrest rhythms.Mechanism of Action: Epinephrine...
12
Local Anesthetics: Clinical Application as Spinal Anesthesia
646
Spinal anesthetics are given during lower abdomen and limb surgeries to block sensory and motor neurons. They are administered in the mid to low lumbar regions, primarily acting on the cauda equina's nerve roots. The blockade level depends on the local anesthetic (LA) concentration. Usually, low LA concentrations are sufficient to block sensory fibers, while only high LA concentrations block motor fibers. Other factors like injection volume and speed, the patient's posture, and the drug...
646
Depolarizing Blockers: Pharmocokinetics
330
Depolarizing blockers are administered through intravenous injection. Succinylcholine is the most common choice of depolarizing blockers in emergency clinical practices. Although they have a rapid onset, they readily diffuse away from the motor end plate into the extracellular fluid. They are metabolized by enzymes such as liver butyrylcholinesterase and plasma pseudocholinesterases. This produces a short duration of action, typically 5-10 minutes long, unlike nondepolarizing blockers, which...
330


